腺苷负荷99m 锝-甲氧基异丁基异腈门控心肌灌注显像在冠心病诊断中的价值

摘要

Objective: To investigate the clinical value of adenosine stress99m Tc-methoxyisobutylisonitrile (99mTc-MIBI) gated myocardial perfusion imaging (G-MPI) in diagnosis of coronary artery disease (CAD), in evaluation of coronary artery branch stenosis and left ventricular function.Methods: A total of 46 patients diagnosed or suspected for CAD, all patients underwent coronary artery angiography (CAG)as golden standard, and meanwhile, the patients received adenosine stress 99mTc-MIBI G-MPI examination. We calculated the sensitivity, specificity and accuracy of adenosine stress G-MPI in diagnosing CAD and judging coronary artery stenosis, we also compared the left ventricular ejection fraction (LVEF) between adenosine stress 99mTc-MIBI G-MPI and ultrasonic echocardiography (UCG).Results: The adenosine stress 99mTc-MIBI G-MPI for CAD diagnosis had the sensitivity:87.0％, specificity:81.8％, accuracy:85. 3％ ,positive predictive value:90. 9％ and negative predictive value:75.0％. The diagnostic sensitivity, specificity and accuracy for left anterior descending artery stenosis were 88. 2％, 81.8％, 86. 7％ respectively, for left circumflex artery stenosis were 78. 6％, 90. 9％, 84. 0％ respectively, for right coronary artery stenosis were 90. 5％, 72. 7％, 84. 4％ respectively. The positive diagnostic rate for 1 branch vessel:83. 3％, for 2-ranch vessel:91.7％, for 3-ranch vessel:90. 9％. There was no real difference in LVEF-G-MPI and LVEF-UCG, it had a positive correlation coefficient (r=0. 885, P=0. 0001).Conclusion :Adenosine stress 99mTc-MIBI G-MPI has significant clinical value for diagnosing CAD and for evaluating coronary artery branch stenosis and left ventricular function.%目的:探讨腺苷负荷99m锝-甲氧基异丁基异腈(99mTc-MIBI)门控心肌灌注显像(G-MPI)诊断冠心病、评价冠状动脉(冠脉)病变及左心室功能的临床价值.方法:46例临床确诊或疑似的冠心病患者,分别行腺苷负荷99mTc-MIBI G-MPI及选择性冠脉造影检查,以冠脉造影为金标准,计算腺苷负荷G-MPI诊断冠心病及冠脉不同血管病变的敏感性、特异性及准确性,同时比较腺苷负荷99mTc-MIBI G-MPI的左心室射血分数(LVEF)与超声心动图的LVEF的相关性.结果:腺苷负荷99mTc-MIBI G-MPI诊断冠心病的敏感性为87.0%,特异性为81.8%,准确性为85.3%,阳性预测值为90.9%,阴性预测值为75.0%.它对判断冠脉各分支狭窄也具有较高的价值,其中左前降支敏感性为88.2%、特异性为81.8%、准确性为86.7%;左回旋支敏感性为78.6%、特异性为90.9%、准确性为84.0%;右冠脉敏感性为90.5%,特异性为72.7%,准确性为84.4%.而且,对冠脉病变支数的检出率分别为1支病变83.3%,2支病变91.7%,3支病变90.9%.腺苷负荷99mTc-MIBI G-MPI的LVEF与超声心动图的LVEF无显著差异,二者呈显著正相关(r=0.885,P=0.0001).结论:腺苷负荷99mTc-MIBI G-MPI对诊断冠心病、评价冠脉病变及左心室功能具有重要的临床价值.